Homebirth and Race and Class

[annakiss]

How does everyone feel about homebirth as a domain of the privileged (not necessarily wealthy, mind you - privileged as in referring "to special powers or 'de facto' immunities held as a consequence of political power or wealth. Privilege of this sort may be transmitted by birth into a privileged class or achieved through individual actions.")?

Do women of privilege seek to keep this to themselves? Do they seek to spread the love? Are there ways in which that might be accomplished?

[GOPLawyer]

History has shown the opposite to be true.

IME, homebirth stretches across such boundaries.

[annakiss]

Allow me to clarify - homebirth in the US. Currently.

[GOPLawyer]

Even more so then.

[annakiss]

Really?

[GOPLawyer]

Really.

Especially considering that the "powers that be" are trying *very* hard to outlaw HB midwives, HB VBACs etc.

Further, every single HBer I know/have come across etc. would LOVE to share the HB love.

[Swandira]

I may be wrong, and I've seen no research on this, but I would guess that planned homebirths, just like nursing past a year, would be more common among the reasonably well educated. Is that what the OP meant?

Nealy
mama to T, 5; L, 2; and EDD 12/20/08

[annakiss]

Of course that's what I meant. I even offered a definition of privileged. I don't mean the upper-most echelon of American social class. I mean the privileged. As in it's not at all available to the poor, really.

[GOPLawyer]

So, by your last post, you are referring to level of monetary wealth. Again, HB is enjoyed by both rich and poor. I would even go so far as to say that HB is more prevalent in the less affluent communities. Hospitals are not exactly cheap and HB midwives are not exactly rich.

[Patchfire]

More than availability, necessarily, I think that the 'underprivileged' (for lack of a better term) disproportionately bear any negative consequences - involvement of CPS, for instance. Of course, that's not in any way limited solely to birth, sadly.

[annakiss]

Originally Posted by GOPLawyer

So, by your last post, you are referring to level of monetary wealth. Again, HB is enjoyed by both rich and poor. I would even go so far as to say that HB is more prevalent in the less affluent communities. Hospitals are not exactly cheap and HB midwives are not exactly rich.

This is exactly the conversation I didn't want to have.

It's not just monetary wealth, it's also issues of race, but class is a more determining factor, though of course class is interrelated with issues of race. Class can include levels of formal education as well. I am currently on assistance for insurance and qualify for food stamps, and yet my husband is getting his PhD - we're middle class even though we don't have cash in the bank necessarily. We enjoy a middle class lifestyle because we have family that is middle class, have good credit, and can work the systems we participate in pretty well due to our education. So it's not cut and dried poor or not poor.

You're over-simplifying it by discussing the relative wealth of hospital systems versus homebirth midwives. People who go to the hospital for birth can qualify for a large variety of assistance that helps pay for their bills. The working poor largely are not made aware of birthing alternatives and can pay off hospital bills for ages. Those who receive assistance can hardly afford the out-of-pocket cost of a midwife. Those who know about homebirth and want it largely can't justify the out-of-pocket cost of a midwife, regardless of whether they're on private insurance or none at all.

Access is largely limited to a select group - largely white, educated, middle class (or higher) women.

[leerypolyp]

Originally Posted by Patchfire

More than availability, necessarily, I think that the 'underprivileged' (for lack of a better term) disproportionately bear any negative consequences - involvement of CPS, for instance. Of course, that's not in any way limited solely to birth, sadly.

I would agree with this.

The shift from homebirth as "that thing poor people do" to "that thing movie stars do" is a very, very recent one, however -- one of the few places traditional midwifery was preserved for a long time was the rural South, in African-American communities.

I know some formerly underground midwives working in the upper South (in a state that now allows CPMs), and I believe their clientele were mainly lower income, working class, as were the midwives themselves. Midwives were white; don't know about all the clients.

[annakiss]

Originally Posted by leerypolyp

I would agree with this.

The shift from homebirth as "that thing poor people do" to "that thing movie stars do" is a very, very recent one, however -- one of the few places traditional midwifery was preserved for a long time was the rural South, in African-American communities.

I know some formerly underground midwives working in the upper South (in a state that now allows CPMs), and I believe their clientele were mainly lower income, working class, as were the midwives themselves. Midwives were white; don't know about all the clients.

I agree. However, the relative surge we're currently experiencing, along with the back-to-nature movement of the late sixties and seventies (spawning Mothering magazine, for instance) is one that is most certainly a thing of privilege.

Of course I think that so is the obsession with parenting minutiae and the associated act of having 15,000+ posts on mothering message boards. ahem... :

[dmarina]

i am non-caucasian and "underpriviledged" wealth-wise, and i am having a homebirth. the women that i've met at my midwives' practice have been a very diverse mix economically, socially and racially.

[annakiss]

Originally Posted by dmarina

i am non-caucasian and "underpriviledged" wealth-wise, and i am having a homebirth. the women that i've met at my midwives' practice have been a very diverse mix economically, socially and racially.

Where are you? That has not been my experience at all.

[GOPLawyer]

Originally Posted by annakiss

This is exactly the conversation I didn't want to have.

It's not just monetary wealth, it's also issues of race, but class is a more determining factor, though of course class is interrelated with issues of race. Class can include levels of formal education as well. I am currently on assistance for insurance and qualify for food stamps, and yet my husband is getting his PhD - we're middle class even though we don't have cash in the bank necessarily. We enjoy a middle class lifestyle because we have family that is middle class, have good credit, and can work the systems we participate in pretty well due to our education. So it's not cut and dried poor or not poor.

You're over-simplifying it by discussing the relative wealth of hospital systems versus homebirth midwives. People who go to the hospital for birth can qualify for a large variety of assistance that helps pay for their bills. The working poor largely are not made aware of birthing alternatives and can pay off hospital bills for ages. Those who receive assistance can hardly afford the out-of-pocket cost of a midwife. Those who know about homebirth and want it largely can't justify the out-of-pocket cost of a midwife, regardless of whether they're on private insurance or none at all.

Access is largely limited to a select group - largely white, educated, middle class (or higher) women.

I can only go by the words that are written on the page. First it was political power, then it was wealth...just trying to pin down exactly to what you are referring. This last post was much clearer.

However, I still disagree. There are posts after posts of discussions about working w/ midwives as to cost, bartering etc.

As far as people being made aware that HB is an option, I think that applies to a vast majority of the population. It's a problem that, again, cuts across class, race etc.

[annakiss]

Originally Posted by GOPLawyer

As far as people being made aware that HB is an option, I think that applies to a vast majority of the population. It's a problem that, again, cuts across class, race etc.

But how do we access that information? If we are in survival mode due to limited resources or limited mobility (literal and figurative), how do we access information that is hidden from view in the mainstream?

[Arwyn]

How many black midwives do you know? Hispanic? Asian? I know of several black midwives, and Midwifery Today makes a point to showcase native midwives from Central and South America, but in my area, which has a saturation of homebirth midwives, I can think of none who are not white and more or less middle class.

For whatever reason, homebirth does seem to be more prevalent among the privileged - privileged by class, race, education, or wealth. Which is not to say there aren't women who are poor, or of color, or with little formal education who have pursued homebirth, only that they are disproportionately underrepresented in the homebirth population.

I would love to see homebirth spread, accessible to all women. Who more than the underprivileged deserve the one-on-one personalized care of a homebirth midwife? Who more needs the empowerment of a natural birth?

But bugger me if I can figure out how I, a middle class white daughter of MD/PhD parents, can make help that happen without being accused (rightly) of colonialization, of trying to tell "those pitiable women" how to live and what choices to make.

[nashvillemidwife]

Originally Posted by Arwyn

How many black midwives do you know? Hispanic? Asian? I know of several black midwives, and Midwifery Today makes a point to showcase native midwives from Central and South America, but in my area, which has a saturation of homebirth midwives, I can think of none who are not white and more or less middle class.

We're saturated with home birth midwives here also, and 3 of them in my immediate area are black, including my partner. There is another that is retired.

[holly6737]

The only homebirthers I know of IRL are white. They are typically college educated and I'd say around middle class so far as lifestyle goes. I'm in NC, if that makes a difference.

Online, though, that's a different story. I think you'll find all kinds of people online who homebirth. The audience is much larger.